DON'T LET YOUR GUARD DOWN
As MRI Technologists, we have the unique distinction of doing life in an area under
constant surveillance. Controlled Access is a really nice way to describe the tedious and not so general
clearance processes to gain entry into our environment.
MRI Safety has become the “hot topic” yet this is an ever growing concern
complicated by the rapid advancement of technology which in turn increases the
potential for more risk.
We cannot afford to permit our thinking to simply be limited to the MRI “Scanner”.
There are so many things to consider, the magnetic field strength,
the gradient slew rate, the fringe fields, RF fields, implanted
devices, patient history, ancillary equipment, supporting staff
from other departments and the list goes onnnnnnnnnn........
All of these things and the collaboration of them dictate the
criteria by which access can be gained. The way we think and
approach our daily tasks must be realigned and intentional.
It’s so easy to have a false sense of security when it comes to breaches in our MRI suites. The truth is, as we become acclimated to the environment, we settle into a place of familiarity and subconsciously take for granted the magnetic field, its strength and the repercussions thereof. A major contributing factor to this is, we seldom hear about “near misses”.
For example, when’s the last time
you heard about a
patients spouse who
despite being diligently
screened by the
technologist made it into
the scan room with his
service revolver strapped to his ankle and as a result suddenly affixed to the side of the magnet ?
How about the MR
compatible pulse oximeter
whose AC plug was sucked
into the magnet as the
technologist walked by the
bore to plug it in?
“As technologists, we
simply cannot afford
to be the weakest link
in the chain of access
to our environments.”
Lisa S. McKenzie, RT, (R)(MR)
Unfortunately, we only hear about the catastrophic incidences, the fatal ones while these sorts of things are happening more frequently than most of us are aware.
MRI Technologists often fall into the precarious place of juggling schedules, emergencies, V.I.P. add ons and the like.....the plethora of realities that oppose us like high energy nuclei opposing the magnetic field - presented in the form of obstacles, that make even the most seasoned Technologist vulnerable.
As “gatekeepers”, we are the last clearance check before gaining access to the MRI environment and we simply cannot afford to be the weakest link.
When it comes to MR Safety there can be no compromise, no sub standard, no
shortcuts.
One breech can put an entire department at risk causing loss of life, equipment
damage/downtime, delays in patient care and even loss wages for hospitals and
staff.
This weeks focus will revolve around the basic processes that help build a good
foundation whereby we can establish and maintain a safe environment for patients
and staff alike.
The most basic place to start is ensuring that all MRI Staff has had MR safety
training.
According to ACR standards, all staff are required to participate in annual MRI safety
training which must be performed and documented with dated signatures. This building block establishes like nothing else our “WHY”, the reason consistent, across the board safety processes are necessary and the importance of EVERYONE being on the same page.
Let’s review a few of the basic principles that help keep us incident free in our MRI
bubbles.
1. ACCESS
The ACR set up a system whereby one can identify the
extent of the magnetic fields’ influence called zones.
These “ Zones” help to ensure that staff, patients and general
population are not exposed to the influence of the magnetic
field without proper screening and clearance.
ZONE 1 - General Public
This zone is free of any influence from the Magnetic field.
It is considered safe for anyone to be in, the general
population of people regardless of their health or surgical
history.
ZONE 2 - Unscreened MRI patients
MRI patient screening and preparation.
This is the furthest anyone can go whether staff, patients
or visitors without through MR screening.
ZONE 3 - Screened MRI patients / personnel
Anyone in this area has filled out a screening form
AND been screened and further interviewed by a member
of the MRI staff to ensure there is NO CONTRAINDICATION
that would be negatively influenced by the magnetic field.
ZONE 4 - Screened MRI patients under constant
direct supervision of trained MR personnel.
This area is RESTRICTED to those whom have been
screened, assessed and have no known contraindications
to being in the presence of the magnetic field.
⁃ That being said, its imperative that we know who and
what is our area at all times.
⁃ That Zones 3 and 4 are monitored and controlled allowing access only to those who have completed MRI safety training and are screened for compatibility.
2. SCREENING
MRI Screening forms are more than just pieces of paper with check boxes and circles, they are legal documents with a signature line. Due diligence is necessary for your own protection as
much as the patients.
Suggestions:
⁃ Review the screening form before you go to get the patient
⁃ Verbally open the dialogue with an introduction and review of surgery, implants, heart or brain surgery - the triggers for areas where devices, implants that require compatibility checks are commonly located.
⁃ Leave NO ROOM for misunderstanding In our climate of limited staff and higher patient volume, it is tempting to expedite the process by verbally asking the screening questions and doing paperwork later.
We’ve all probably done it or seen it done but in the grand scheme of things, is
taking this kind of risk, every really worth the extra few minutes you saved in the
event it goes wrong ?
3.COMPATIBILITY
“When in doubt - KEEP IT OUT of the scan room!”
Every facility has policies and procedures as to the
verification and clearance of implants/devices when questions arise.
⁃ It behooves us to find it AND familiarize ourselves with it BEFORE we need it.
⁃Follow that policy and procedure
⁃Consult your supervisor, Radiologist, MR Safety Officer
As inconvenient as it may be, the time it takes to verify the
information is a small, price to pay to prevent unnecessary
harm to a patient
There are resources to quickly identify a devices MR
compatibility when the patient knows the implant type or
description.
Here are a couple of the most frequented ones:
In the event a patient has no card, device, serial # information, refer to your departments policies and procedures as each facility has a different way of ensuring patient safety and due diligence to provide patient care that is not compromised.
Some suggestions that might be helpful are:
- Imaging reports of MR performed after implantation on field strength comparable to the one going to be used
⁃ Dr office notes that contain the implant manufacturer and implant date, serial number, etc to accommodate verification of compatibility
⁃ CT or X-rays, dependent on radiologists preference to exclude the presence of metal
4.HEARING PROTECTION
The decibel level of high field MRI systems 1.5T and higher can cause permanent damage to your hearing over extended periods of exposure. No patient should have a High Field MRI without the
protection of MRI approved earplugs or headphones.
I am simply astonished at the amount of patients I’ve
scanned within the past year, who emphatically express
concern when they are offered earplugs because, “I’ve
had several MRIs and this is the first time I’ve ever been
offered earplugs”.
What if your patient doesn’t want them?
Well, on my watch it’s not an option and I tell them so, no earplugs/headphones no scan.
EVERYONE in the MRI room during a scan should have
hearing protection in the form of earplugs or MR
compatible headphones. There’s nothing you or I can do to make them keep them in, that being said there has not been a single patient that was upset because they “had to” have earplugs at the completion of their study.
5.EXCESSIVE HEATING AND RF BURNS
Positioning is an integral and essential part of the exam, not merely for beautiful pictures but also to help protect the patient from the possibility of RF heating and burns. In most MRI systems the body coil is used to transmit the RF or radio frequency pulses to create signal in some sequences particularly the ones involving the larger body
and trunk work. When a patients arms and legs are touching the sides of the bore, create closed loops by being crossed or cupped or have skin to skin contact they absorb that RF
which can raise the temperature of the tissues internally and cause RF burning.
Prevention:
⁃ Change all patients into gowns or scrubs to eliminate the
influence of metallic material
⁃ Ensure there is manufacturer approved padding between the patient and any
anatomy touching the sides of the bore
⁃ Ensure that the patients hands, arms, legs, feet are uncrossed
⁃ Ensure Cords from coils, leads, monitors, etc. are not looped, twisted, coiled,
touching the patients skin directly or touching the side of the bore
⁃ Ensure the patients actual weight is what you type into the demographics on the
MRI scanner - this actually dictates the Specific Absorption Rate (SAR) allowed
for a patient and thereby the allowed amount of RF energy for that patient.
We will talk about this in another session.
- Ensure there are no unnecessary metallic objects touching the patients skin
(medication patches with metallic properties, jewelry, etc)
6. SITUATIONAL AWARENESS OF THE HAPPENINGS IN YOUR ENVIRONMENT
- Eliminate the possibility of things that are not safe finding their way into your scan room.
This can be accomplished by ensuring that anything not MRI safe, that is not absolutely, positively necessary to accomplish your job doesn’t even find a resting place in Zones 3 or 4.
The reality is, no matter how many “zones” a patient, visitor or staff get through, we cannot rely on screening that did or did not take place prior to the patient being placed in our care.
It is our responsibility, our duty to not “let our guards down”, to not allow familiarity,
time, or any external pressure to compromise our environment or the safety of our
patients. Our job entails more than acquiring high quality diagnostic images, it requires that
we are advocates for safety that ensures we accomplish the best possible exam in the safest way possible.
Until the next time....
Safe scanning
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